Geriatrician assessment and immortal time bias in the FiTR 2 study
Authors: Sarah L van Dalen, Jeannette A Goudzwaard, Martijn W F van den Hoogen
Journal: The Lancet Healthy Longevity (2022)

We read with great interest the Article by Philip Braude and colleagues1Braude P Short R Bouamra O et al.A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study.Lancet Healthy Longevity. 2022; 3: e549-e557Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar about the application of a geriatrician assessment in multiple trauma centres in England. Investigating the possible benefits of a geriatrician assessment in a broader field than just geriatric care has the potential to give an insight on how to improve health care for older people in a world with an ageing population. In the Article,1Braude P Short R Bouamra O et al.A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study.Lancet Healthy Longevity. 2022; 3: e549-e557Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar the authors conclude that the performance of a geriatrician assessment is associated with a lower mortality in older people. However, the authors did not clearly define geriatrician assessment, and the study was performed in multiple centres. Could it be possible that some patients received a comprehensive geriatrician assessment whereas others were only screened for frailty? If so, was there a difference in outcome? Moreover, there is no information available on the altered care given to the patient after geriatrician assessment. We believe that the answers to both questions are important to correctly interpret the findings of the FiTR 2 trial. Moreover, when looking at the Kaplan-Meier curves,1Braude P Short R Bouamra O et al.A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study.Lancet Healthy Longevity. 2022; 3: e549-e557Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar the difference in survival between the two groups is clear, but made in the first few days after geriatrician assessment. Could it be possible that bias was introduced in patients that did or did not receive a geriatrician assessment? We wonder if the difference in survival between the two groups (geriatrician assessment vs non- geriatrician assessment) might be caused by performing assessments at the weekend, assuming geriatrician assessments are performed more routinely during the week. It is known that the mortality during weekends is higher than that during the week,2Honeyford K Cecil E Lo M Bottle A Aylin P The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis.BMC Health Serv Res. 2018; 18: 870Crossref PubMed Scopus (50) Google Scholar which might also explain the Kaplan-Meier curve. Can the authors share data on the performance of geriatrician assessment on weekends versus weekdays? This online publication has been corrected. The corrected version first appeared at thelancet.com/healthy-longevity on December 5, 2022 This online publication has been corrected. The corrected version first appeared at thelancet.com/healthy-longevity on December 5, 2022 MWFvdH reports honoraria from Astellas, Astra-Zeneca, Chiesi, GSK, Mundipharma, Novonordisk, Sanofi Genzyme, and Vifor; and research grants from Astellas and Novartis. SLvD and JAG declare no competing interests. A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort studyGeriatrician assessment was associated with a reduced risk of death for seriously injured older people. These data support routine provision of geriatrician assessment in trauma care. Future research should explore the key components of a geriatrician assessment paired with a health economic evaluation. Full-Text PDF Open AccessCorrection to Lancet Healthy Longev 2022; 3: e735van Dalen SL, Goudzwaard JA, van den Hoogan M. Geriatrician assessment and immortal time bias in the FiTR 2 study. Lancet Healthy Longev 2022; 3: e735—In this Correspondence, the spelling of the author Martijn WF van den Hoogen's name was incorrect. This correction has been made as of Dec 5, 2022. Full-Text PDF Open Access